CMM-201: Facet Joint Injections/Medial Branch Blocks

Covered: diagnostic facet joint injections/medial branch blocks are medically necessary for chronic neck or back pain only when all criteria are met—pain provoked by facet loading, ≥4 weeks of conservative therapy (or documented contraindication), imaging excludes other causes, target segment not posteriorly fused, procedure performed with fluoroscopic or CT guidance, and a diagnostic block must produce ≥80% relief for the expected anesthetic duration (a second confirmatory block is allowed if the first is positive and radiofrequency ablation [RFA] is being considered; therapeutic repeats permitted ≥6 months later only if prior injections gave >50% relief for ≥12 weeks and RFA is contraindicated). Excluded/experimental: ultrasound guidance, biologic injectates, injections at fused levels (except pseudoarthrosis or specified adjacent levels), same-day other injections, >3 contiguous levels, atlanto‑occipital/atlanto‑axial injections, more than two blocks at the same level, and all other deviations; required documentation includes physical findings, imaging, conservative treatment, levels treated, guidance used, percent pain relief, and procedure intent.